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Pharmacology · Aminoglycosides

Streptomycin !

The first aminoglycoside; given intramuscularly for tuberculosis, plague, tularemia and brucellosis. It damages balance more than hearing.

Updated 2026-11-01

  • Class: Aminoglycosides
  • Target: 16S rRNA and ribosomal protein S12 of the bacterial 30S subunit
  • ATC code: J01GA01
  • WHO Model List of Essential Medicines

The figure shows streptomycin in the 30S ribosomal subunit of Thermus thermophilus, a bacterium whose ribosome is a standard model for drug binding.

Target in 3D: 16S rRNA and ribosomal protein S12 of the bacterial 30S subunit. PDB structure 4DR3 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Streptomycin binds the 30S subunit, where the 16S rRNA and ribosomal proteins form its site. It freezes ribosomes at the start of translation and causes misreading, so the bacterium makes useless proteins and dies. Its spectrum is narrower than gentamicin's, but it is active against Mycobacterium tuberculosis, Yersinia pestis, Francisella tularensis and Brucella.

  1. Binds the 30S subunit of the ribosome
  2. Ribosomes stall at the start codon
  3. Misreading yields faulty proteins
  4. The bacterium dies

Pharmacokinetics

Absorption
Given by intramuscular injection; peak levels within about an hour.
Distribution
Reaches most tissues and tuberculous cavities but not the brain; crosses the placenta, with cord levels similar to the mother's.
Elimination
Unchanged in the urine; accumulates in kidney failure.

Indications

  • Tuberculosis, within multidrug regimens, when first-line drugs cannot be used or as an added drug. Tuberculosis →
  • Plague (Yersinia pestis) and tularemia (Francisella tularensis).
  • Brucellosis, as a second-line agent within combination treatment. Brucellosis →
  • Enterococcal endocarditis, with penicillin, when the strain is resistant to gentamicin but not to streptomycin. Infective endocarditis →

Adverse effects

Common

  • Vestibular toxicity: nausea, vomiting, vertigo, unsteadiness
  • Paresthesia of the face
  • Rash, fever, urticaria, eosinophilia
  • Pain at the injection site

Contraindications

  • Hypersensitivity to streptomycin or another aminoglycoside

Key interactions

Other neurotoxic or nephrotoxic drugs (other aminoglycosides, polymyxins, vancomycin, cisplatin)
Added toxicity; avoided together.
Potent diuretics (furosemide, ethacrynic acid)
More ototoxicity.
Neuromuscular blockers and anaesthetics
Prolonged paralysis, apnea.

What is monitored

  • Vestibular function and audiometry before and during treatment
  • Kidney function; levels when the kidney is impaired
  • Response of the infection (sputum smears and cultures in tuberculosis)

Administration and safety

  • Intramuscular only, deep in a large muscle; injection sites are rotated.
  • Staff who prepare it avoid skin contact: it can cause skin sensitization.
  • Part of a combined regimen in tuberculosis; never used alone, to avoid resistance.

Nursing care

  • Baseline hearing, balance and creatinine; ask about vertigo and headache, which can precede vestibular damage.
  • Check gait and fall risk, especially in older adults.
  • Support adherence to the full tuberculosis regimen.
  • Teaching: report dizziness, ringing, numbness around the mouth, vision change or rash.

Pregnancy and breastfeeding

Streptomycin readily crosses the placenta and has caused irreversible bilateral congenital deafness; it is avoided in pregnancy whenever another option exists.

Test yourself

Think of the answer, then tap the question to see it.

Which part of the inner ear does streptomycin damage most?

The vestibular system: vertigo, nausea and unsteadiness come before, and are more common than, hearing loss.

Which two zoonotic infections does streptomycin classically treat?

Plague (Yersinia pestis) and tularemia (Francisella tularensis); it is also a second-line drug for brucellosis.

Why is streptomycin avoided in pregnancy?

It crosses the placenta easily and has caused irreversible bilateral congenital deafness.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - STREPTOMYCIN injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 59 (McGraw Hill, 2023); RCSB PDB - 4DR3: Crystal structure of the Thermus thermophilus (HB8) 30S ribosomal subunit with streptomycin bound (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.